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A randomized comparison between ultrasound- and fluoroscopy-guided third occipital nerve block.

Abstract：

BACKGROUND:Third occipital nerve block (TONB) is commonly used in the diagnosis and treatment of upper neck pain and cervicogenic headaches. Although fluoroscopy is the current imaging standard for TONB, ultrasound (US) guidance offers a promising, radiation-free alternative. In this randomized, observer-blinded trial, we compared the 2 imaging modalities. Our research hypothesis was that US guidance would result in a shorter performance time. METHODS:Forty patients undergoing TONB were randomized to fluoroscopy or US guidance. A mixture of local anesthetic and radiographic contrast was injected in both groups. The primary outcome was performance time. Secondary outcomes included success rate, pain levels before and after block, area of sensory hypoesthesia, quality of the block (assessed by electrical perceptual threshold), and procedure-related complications. RESULTS:Ultrasound guidance was associated with a significantly shorter performance time (212.8 vs 396.5 seconds; P = 0.000) and fewer needle passes (2 vs 6; P = 0.000). Both imaging modalities, however, resulted in similar success rates (95%-100%). Furthermore, no intergroup differences were found in preblock and postblock pain scores. In both groups, TONB produced hypoesthesia that was most profound in the suboccipital region. In the fluoroscopy group, C2-C3 intra-articular spread of radiographic contrast and vascular breach were noted in 15% and 10% of patients, respectively. In contrast, no adverse events occurred with US guidance. CONCLUSIONS:Fluoroscopy and US guidance provide similar success rates for TONB. However, ultrasonography is associated with improved efficiency (decreased performance time, fewer needle passes).

journal_name

Reg Anesth Pain Med

journal_title

Regional anesthesia and pain medicine

authors

Finlayson RJ,Etheridge JP,Vieira L,Gupta G,Tran DQ

doi

10.1097/AAP.0b013e31828b25bc

subject

Has Abstract

pub_date

2013-05-01 00:00:00

pages

212-7

issue

3

eissn

1098-7339

issn

1532-8651

journal_volume

38

pub_type

杂志文章,随机对照试验

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